Health Innovation Highlights: January 10, 2018

Full Edition

FROM THE CENTER & OUR PARTNERS

Center Director Ann Hwang in the News

Center Director Dr. Ann Hwang authored a commentary in Modern Healthcare highlighting the use of obfuscatory language by CMS Administrator Seema Verma in discussing the future direction of the Center for Medicare and Medicaid Innovation. While using ostensibly positive phrases like “consumer empowerment” and “patient-centered care,” Verma uses this language in ways that hide the administration’s agenda to increase costs on consumers and create new barriers to care. Dr. Hwang is also quoted in a recent Bloomberg article on Non-Emergency Medical Transportation (NEMT). The Center has organized a workgroup of advocates who meet regularly to discuss improving NEMT services across the country and has also co-authored a brief on NEMT.

Dr. Hwang Named to National Advisory Board

Center Director Dr. Ann Hwang has been named to the National Advisory Committee of SIREN (Social Interventions Research and Evaluation Network).  SIREN’s mission is to disseminate high-quality research that advances efforts to address social determinants of health (SDH) in health care settings, a key element of the Center’s mission as well.

A Policy Roadmap for Individuals with Complex Care Needs

The Bipartisan Policy Center (BPC) is hosting a panel discussion, “A Policy Roadmap for Individuals with Complex Care Needs,” that will feature several staff and partners of the Center.  The event will take place on Jan. 31 from 10 to 11:30 a.m.  at 1225 Eye Street, NW, Suite 1000 in Washington, D.C. t The presentation features Marc Cohen, research director at the Center and leader of the Center’s research partnership with the Gerontology Institute of the University of Massachusetts, Boston. Also featured will be Judy Feder, a Center senior leader. Judy works with several Center state-based partners, providing policy expertise and mentoring. And finally, Cindy Mann, former Director of the Center for Medicaid and  and a Community Catalyst Strategic Advisor, also will be a featured speaker.  Register here to attend in person, and here to listen to the webcast.

INTERVIEW WITH AN INNOVATOR

Interview With an Innovator is an occasional feature in which we pose five questions to a person making a difference in moving our health care system toward one that is more person-centered, equitable and successful in meeting the needs of people with complex health and social needs. 

Vincent DeMarco is a longtime advocate for public health causes including reducing teen smoking and gun violence and expanding health care access. As President of the Maryland Citizens’ Health Initiative, he is working to guarantee quality, affordable health care for all Marylanders. He has been recognized for his work by organizations such as The Baltimore Sun which declared him “Marylander of the Year” in 1988 and the Central Maryland Ecumenical Council which awarded him its 2002 “Ecumenical Leadership Award.” Families USA also recognized DeMarco at the 2007 Health Action forum as “Health Advocate of the Year.”

What led you to get involved with health care advocacy?

I have always been motivated to work on improving public health. I spent most of the 80s and 90s working on successfully preventing gun violence and reducing teen smoking in Maryland. In 1999, after the failure of the Clinton health plan, I joined other Marylanders in forming the Maryland Citizens’ Health Initiative to try to move the health care issue in Maryland. I believe strongly that one of the most important ways to improve public health is to make sure everyone has quality, affordable health care insurance coverage. We made great strides in Maryland before the Affordable Care Act, expanding Medicaid enough to bring Maryland from 32nd in the nation to 16th in health care coverage for lower income people, and have done much to help make the Affordable Care Act a great success in our state.

What’s the most pressing issue you’re working on right now?

Like other health care advocates across the country, our most important issue is to make sure that the gains we have made in Maryland through our own work and under the Affordable Care Act are not rolled back and that we keep moving forward. I am honored to be a member of our new Maryland Health Insurance Coverage Protection Commission, created by the Maryland General Assembly at our request. The Commission is charged with monitoring what happens at the federal level and making recommendations on how to protect health care coverage in Maryland and build on our past successes to achieve our goal of quality, affordable health care for all Marylanders.

What’s the oddest job/assignment you’ve ever had?

When I worked at a law firm many years ago I was asked to track down the name of someone who had reported problems at a nuclear power plant which our firm represented. I said I would not do that. They were not happy. They did not fire me, but I soon left the firm to work at the Maryland Attorney General’s Office.

How are you addressing health equity in your work?

We work closely with organizations such as the NAACP and Latino organizations in our state as well as with faith leaders to make sure that our work addresses equity concerns. With their input we have made it a top priority to address skyrocketing prescription drug prices which have a disproportionately negative impact on lower income Marylanders. We have also created the Maryland Faith Health Network which brings congregations together with hospitals to keep congregants healthy, and many of the congregations with which we are working are in communities of color.

What’s the last great thing you read?

“East of Eden” by John Steinbeck.

NOTEWORTHY NEWS & RESOURCES

CEO of Home Health Corporation Reported as Possible Candidate to Lead Innovation Center

POLITICO reports that Adam Boehler, founder and CEO of California-based home health corporation Landmark Health, is a top contender to lead CMS’ Innovation Center. Created by the Affordable Care Act to find new ways to lower health care costs, the Innovation Center is expected to focus its upcoming work on flexible payment models and patient decision-making. Boehler’s background as a health care venture capitalist with virtually no distinguishable political ties makes him unusual among Trump appointees, and one who is likely to garner bipartisan support. The position has been vacant since October, when its previous director, Patrick Conway, became president and CEO of Blue Cross Blue Shield of North Carolina.

New Tools for Strengthening Medicaid Long-Term Services and Supports

The Center for Health Care Strategies has released a new toolkit designed to states in developing Long-Term Services and Supports (LTSS) reform strategies in two ways: matching care settings to individual needs and advancing integration of LTSS with physical and behavioral health services through managed care. The toolkit’s strategic recommendations include:

  • Developing LTSS system infrastructure;
  • Investing in programs that keep nursing residents in their own communities;
  • Expanding access to home and community based services;
  • Integrating benefits for dual-eligibles;
  • Using capitated managed care programs to improve outcomes for Medicaid beneficiaries; and
  • Including individuals with intellectual/developmental disabilities in managed care systems.

In addition to strategies, the toolkit provides case studies from states that have enacted reforms, detailed results and key takeaways that can be replicated in other states.

What’s Stopping Women’s Workforce Participation? Elder Care.

A New York Times article discusses the critical impact elder care has on American women’s workforce participation. While traditional wisdom dictates that childcare is the primary cause of labor-force stagnation for women in prime working years, new labor analyses are starting to account for the increasingly large number of aging Americans requiring respite and long-term care, the responsibility for which is also falling on women. Over the next 12 years, more than one-fifth of Americans will reach retirement age, and without expanding the social safety net to include universal long-term care services, millions of wives and daughters, and likely an increasing number of sons, will be forced to leave the labor market to provide care. Given the gridlock at the national level, states will have to take the lead in developing long-term care policies and in ensuring that the corresponding paid care workforce is prepared and sustainable. 

STATE HIGHLIGHTS

California

In early December, The SCAN Foundation and University of California, San Francisco released their fifth wave of survey data about the experiences of beneficiaries enrolled in Cal MediConnect, the state’s dual eligible demonstration project. Overall, the data show that CMC enrollees continue to experience higher levels of satisfaction with their health care services than those not in a CMC plan. As in previous findings, CMC enrollees continue to be less satisfied with their choice of doctors than beneficiaries who opted out, though this new data shows that enrollees reporting this problem decreased from 23 percent in 2015 to 18 percent in 2017.

Colorado

A new report by the Colorado Health Institute, “Managing Medicaid in Colorado, The Promise of Medicaid Managed Care,” discusses three models the state has used to date to try to control the state’s Medicaid costs, and outlines the case for moving to a full Medicaid Managed Care approach. Enrollment in Health First Colorado, the state’s Medicaid program, has grown rapidly, and the state’s costs have grown, too. More than 1.3 million Coloradans are covered by Medicaid, and the shared federal-state program now accounts for 26 percent of the state General Fund, up from 18 percent in fiscal year 2001-2002.

Colorado’s Medicaid program has focused on placing its enrollees in medical homes, largely avoiding a statewide adoption of a more aggressive capitated payment structure. Still, Colorado is taking some important steps down the Medicaid managed care road. The Department of Health Care Policy & Financing (HCPF) has launched three initiatives that rely, at least in part, on managed care tenets. The report gives an overview of these three programs, discussing for each one: contracts, use of medical homes, capitated payment features and results to date. The programs are:

  • Accountable Care Collaborative (ACC) – HCPF in 2011 launched this groundbreaking effort to rethink how it delivers care to Colorado’s Medicaid enrollees. The ACC has grown rapidly, and today it covers more than one million of Medicaid’s nearly 1.3 million members. Seven Regional Care Collaborative Organizations (RCCOs) manage the program, connecting enrollees to primary and specialty care.
  • Rocky Mountain Health Plans (RMHP), a health insurance company that has operated in western Colorado for more than 40 years, launched its Medicaid Prime program in 2014 as a component of the ACC.
  • Denver Health Medicaid Choice (DHMC) – This program is furthest along the Medicaid managed care path. While it has all three hallmarks of a full Medicaid managed care program, it is available only in four metro Denver counties. Launched in 2004 by Denver Health, a comprehensive care safety net organization, it now covers about 89,000 enrollees. DHMC uses a closed network, which means enrollees must use Denver Health physicians and facilities.

Pennsylvania

On January 1, Community Health Choices (CHC), the state’s mandatory managed long-term services and supports program officially started. About 85,000 people, including dually eligible individuals and those with physical disabilities, are enrolled in the program so far in southwest Pennsylvania, where the program is first rolling out before it moves to other parts of the state. There are three managed care organizations contracted to serve this population: UPMC, PA Health and Wellness and AmeriHealth. Center partner, the Pennsylvania Health Access Network (PHAN) is working hard to make sure CHC works for older adults and people with disabilities. The program will roll out in Southeast Pennsylvania in Jan. 2019 and in the rest of the state in Jan. 2020. Learn more about the program at: http://pahealthaccess.org/chc.

KEY DATES

Tuesday, Jan. 16 (2-3 p.m. Eastern) – Webinar: Frontotemporal Degeneration: The Importance of Knowledge, Advocacy and Support to Advance Quality Care, presented by the American Society on Aging and sponsored by the Administration for Community Living.

Please register for the webinar.

Thursday, Jan. 25 (12-1 p.m. Eastern) – Informational Webinar on the MIT Abdul Latif Jameel Poverty Action Lab North America (J-PAL North America) second Health Care Delivery Innovation Competition.

Please register for the webinar. 

Thursday, Jan. 25 (2-6 p.m. Eastern) – Webinar: Expanding the Bounds of Care Delivery: Integrating Mental, Social, and Physical Health, presented by NEJM Catalyst.

Please register for the webinar.

Wednesday, Jan. 31 (10-11:30 a.m. Eastern) Panel Discussion: A Policy Roadmap for Individuals with Complex Care Needs, hosted by the Bipartisan Policy Center.

Please register here to attend in person, and here to listen to the webcast.

Friday, Feb. 16 (2:30-3:30 a.m. Eastern) – Webinar: A Conversation with Dr. Atul Gawande presented by Grantmakers In Aging, and made possible through the sponsorship of The John A. Hartford Foundation.

Please register for the webinar.